Good mid-term outcome of the rotating hinge knee in primary total knee arthroplasty – Results of a single center cohort of 106 knees with a median follow-up of 6.3 years

BackgroundThe prognosis of complex primary total knee arthroplasty (TKA) with severe deformity and ligament deficiency is not clear. There is a paucity of evidence in the current literature on treatment outcomes of the rotating hinge knee implants in primary TKA. The aim of this study was to determine the mid-term clinical, radiographic, and health-related quality of life (HRQoL) outcomes in patients who had undergone complex primary TKA using single hinged knee replacement.MethodsIn total, 106 complex primary TKAs (101 patients) were performed using the single rotating hinged knee (RHK) implant design at our institution between January 2004 and December 2013. We conducted a retrospective analysis of prospectively collected outcome data of these patients, obtaining also information on all possible revision surgeries from the Finnish Arthroplasty Register, and conducted a prospective follow-up study of all living patients.ResultsThe 10-year Kaplan-Meier survival rate of the RHK knees was 91.6% (95% CI 86.0% to 97.2%) with revision for any reason as the endpoint. Overall, eight knees (7.5 %) underwent revision surgery during the follow-up. None of the unrevised RHK knees were radiographically loose. The majority of patients evinced good clinical outcome and quality of life as measured with patient reported outcome measures.ConclusionThe hinge knee replacement which was assessed current study can be regarded as a suitable option in complex primary TKA, provided adequate attention is paid to the correct indications and patient selection.     

国内住培中医患沟通研究现状的分析与思考

目的通过文献计量法分析国内住院医师规范化培训(简称住培)中关于医患沟通的研究现状,为提高住培过程中医患沟通能力提出建设性对策。方法应用文献检索策略,在中文期刊全文数据库搜索并导出自2000年1月1日—2020年2月29日以来有关住培中医患沟通的全部文献,以文献标题、发表时间和研究内容等构建Excel数据库,并进行统计分析。结果查到住培相关医患沟通的相关文献共70篇,均于2009年以后发表,文献研究数量逐年增加;文献作者所在地域分布不均匀;作者单位主要以大学附属医院为主;文献多出自于教育类、临床类和管理类期刊;文献的研究方法主要以理论论述为主,缺乏干预性研究;文献的被引次数较低,文献质量相对较差;文献的研究内容主要对医患沟通的重要性、内涵建设、现状与挑战和提高医患沟通措施方面进行了阐述。结论医患沟通培训在住培中并未受到充分重视,需在住培期间加强医患沟通教育,培养医患沟通能力,为创建新型医患关系奠定坚实的基础。     

COVID-19 in the endoscopy unit: How likely is transmission of infection? Results from an international,multicenter study

BACKGROUND Coronavirus disease 2019(COVID-19) significantly affected endoscopy practice,as gastrointestinal endoscopy is considered a risky procedure for transmission of infection to patients and personnel of endoscopy units(PEU).AIM To assess the impact of COVID-19 on endoscopy during the first European lockdown(March-May 2020).METHODS Patients undergoing endoscopy in nine endoscopy units across six European countries during the period of the first European lockdown for COVID-19(MarchMay 2020) were included. Prior to the endoscopy procedure, participants were stratified as low-or high-risk for potential COVID-19 infection according to the European Society of Gastrointestinal Endoscopy(ESGE) and the European Society of Gastroenterology and Endoscopy Nurses and Associates(ESGENA) joint statement, and contacted 7-14 d later to assess COVID-19 infection status. PEU were questioned regarding COVID-19 symptoms and/or infection via questionnaire, while information regarding hospitalizations, intensive care unitadmissions and COVID-19-related deaths were collected. The number of weekly endoscopies at each center during the lockdown period was also recorded.RESULTS A total of 1267 endoscopies were performed in 1222 individuals across nine European endoscopy departments in six countries. Eighty-seven(7%) were excluded because of initial positive testing. Of the 1135 pre-endoscopy low risk or polymerase chain reaction negative for COVID-19, 254(22.4%) were tested post endoscopy and 8 were eventually found positive, resulting in an infection rate of 0.7% [(95%CI: 0.2-0.12]. The majority(6 of the 8 patients, 75%) had undergone esophagogastroduodenoscopy. Of the 163 PEU, 5 [3%;(95%CI: 0.4-5.7)] tested positive during the study period. A decrease of 68.7%(95%CI: 64.8-72.7) in the number of weekly endoscopies was recorded in all centers after March 2020. All centers implemented appropriate personal protective measures(PPM) from the initial phases of the lockdown.CONCLUSION COVID-19 transmission in endoscopy units is highly unlikely in a lockdown setting, provided endoscopies are restricted to emergency cases and PPM are implemented.     

Mask mandates save lives

We quantify the effect of statewide mask mandates in the United States in 2020. Our regression discontinuity design exploits county-level variation in COVID-19 outcomes across the border between states with and without mandates. State mask mandates reduced new weekly COVID-19 cases, hospital admissions, and deaths by 55, 11, and 0.7 per 100,000 inhabitants on average. The effect depends on political leaning with larger effects in Democratic-leaning counties. Our results imply that statewide mandates saved 87,000 lives through December 19, 2020, while a nationwide mandate could have saved 57,000 additional lives. This suggests that mask mandates can help counter pandemics, particularly if widely accepted.     

The Effects of the 2020 COVID-19 Lockdown on Mood,Behavior, and Social and Cognitive Functioning in Older Long-Term Care Residents

ObjectivesWe aimed to explore the effects of the Dutch COVID-19 lockdown (March 20–May 25, 2020) on mood, behavior, and social and cognitive functioning of older residents of long-term care facilities (LTCFs) prospectively.DesignMixed methods: historically controlled longitudinal cohort study and focus groups.Setting and ParticipantsResidents of Dutch LTCFs.MethodsResidents who were assessed during and prior to the lockdown were compared to residents of the same wards with 2 assessments prior to the lockdown. We used mixed models and generalized estimating equation analyses to explore differences in changes in mood, withdrawal and aggressive behavior, loneliness and conflict, and cognition and delirium. We also explored whether the effect of the lockdown differed for different subgroups. In 2 online focus groups, LTCF care professionals, ranging from care staff to physicians, reflected on their experiences of the effect of the lockdown and the cohort study results.ResultsThe lockdown group of 298 residents was compared to the control group of 625 residents. Self-reported mood symptoms showed a slightly greater increase during the lockdown. During the first half of the lockdown, the level of conflict with other residents decreased whereas it increased in the control group. The subgroup with moderate-severe cognitive impairment showed a decrease in withdrawal during the lockdown, whereas the group with no-mild cognitive impairment showed a statistically nonsignificant relative increase. Professionals described great individual variation in the effects of the lockdown on residents. Facilities attempted to preserve the experienced positive effects, for example, by promoting tranquility in shared rooms and continuing to organize individualized ward-based activities.Conclusions and ImplicationsWe did not find clinically relevant negative effects of the lockdown on mood, behavior, and social and cognitive functioning in older residents of LTCFs at the group level. Possibly, staff mitigated the negative effects at the group level. Meanwhile, they learned lessons that they continue to apply to enhance resident well-being.     

Mixed-mode versus paper surveys for patient-reported outcomes after critical illness: A randomised controlled trial

ObjectiveThe aim of the study was to determine the response rate to a mixed-mode survey using email compared with that to a paper survey in survivors of critical illness.DesignThis is a prospective randomised controlled trial.SettingThe study was conducted at a single-centre quaternary intensive care unit (ICU) in Adelaide, Australia.ParticipantsStudy participants were patients admitted to the ICU for ≥48 h and discharged from the hospital.InterventionsThe participants were randomised to receive a survey by paper (via mail) or via online (via email, or if a non-email user, via a letter with a website address). Patients who did not respond to the initial survey received a reminder paper survey after 14 days. The survey included quality of life (EuroQol-5D-5L), anxiety and depression (Hospital Anxiety and Depression Scale), and post-traumatic symptom (Impact of Event Scale-Revised) assessment.Main outcome measuresSurvey response rate, extent of survey completion, clinical outcomes at different time points after discharge, and survey cost analysis were the main outcome measures. Outcomes were stratified based on follow-up time after ICU discharge (3, 6, and 12 months).ResultsA total of 239 patients were randomised. The response rate was similar between the groups (mixed-mode: 78% [92/118 patients] vs. paper: 80% [97/121 patients], p = 0.751) and did not differ between time points of follow-up. Incomplete surveys were more prevalent in the paper group (10% vs 18%). The median EuroQol-5D-5L index value was 0.83 [0.71–0.92]. Depressive symptoms were reported by 25% of patients (46/187), anxiety symptoms were reported by 27% (50/187), and probable post-traumatic stress disorder was reported by 14% (25/184). Patient outcomes did not differ between the groups or time points of follow-up. The cost per reply was AU$ 16.60 (mixed-mode) vs AU$ 19.78 (paper).ConclusionThe response rate of a mixed-mode survey is similar to that of a paper survey and may provide modest cost savings.     

Residual limb strength and functional performance measures in individuals with unilateral transtibial amputation

BackgroundIndividuals with lower limb amputation exhibit lower residual limb strength compared to their sound limb. Deficits in residual limb knee flexion and extension strength may impact functional performance during tasks relevant to daily living.Research questionDoes knee flexor and extensor strength in the residual limb impact functional outcome measures, such as walking energetics and performance metrics, in individuals with unilateral transtibial amputation?MethodsFourteen individuals with traumatic unilateral transtibial amputation were recruited for this observational study. Participants completed metabolic testing at three standardized speeds based on leg length, as well maximum isokinetic knee flexion and extension strength for both residual and sound limbs. Participants also completed a series of functional outcome tests, including a two-minute walk test, timed stair ascent test, and four-square step test. Walking energetics (metabolic cost, heart rate, and rating of perceived exertion) and performance metrics were compared to percent deficit of residual limb to sound limb knee flexion and extension muscle strength. A linear regression assessed significant relationships (p < 0.05).ResultsA significant relationship was observed between percent deficit of knee extension strength and heart rate (p = 0.024) at a fast walking speed. Additionally, percent deficit knee flexion strength related to rating of perceived exertion at slow and moderate walking speeds (p = 0.038, p = 0.024). Percent deficit knee extension strength related to two-minute walk time performance (p = 0.035) and percent deficit knee flexion strength related to timed stair ascent time (p = 0.025).SignificanceThese findings suggest the importance of strength retention of the residual limb knee flexion and extension musculature to improve certain functional outcomes in individuals with unilateral transtibial amputation.     

Characterizing the Performance of the Nation’s Hospitals in the Hospital Outpatient Quality Reporting Program’s Imaging Efficiency Measures

PurposeTo describe the performance of the nation’s hospitals in terms of the Hospital Outpatient Quality Reporting Program’s imaging efficiency measures.MethodsData were obtained from the Hospital Compare website and reflect outpatient Medicare claims of 4,118 hospitals for 5 imaging efficiency metrics: (1) frequency of combination abdominal CT (performed with and without intravenous contrast); (2) combination chest CT (performed with and without intravenous contrast); (3) simultaneous brain/sinus CT; (4) mammography follow-up (diagnostic imaging after screening mammography); and (5) lumbar spine MRI for low back pain without prior conservative therapy. Metrics were summarized and compared with other hospital characteristics.ResultsMedian frequency was 36.7% for lumbar spine MRI for low back pain and ranged from 1.6% to 7.8% for the remaining measures; however, extreme outliers were observed (maximal frequencies of 79.2%-95.2% for mammography follow-up and combination chest and abdominal CT). Essentially no correlation was found among measures, aside from combination abdominal and chest CT. For some measures, relatively poor performance was more commonly observed among critical access hospitals and physician-owned/proprietary hospitals, and less commonly observed among U.S. News & World Report “best” hospitals and primary residency teaching sites. Frequencies for combination abdominal and chest CT improved from 2013 to 2014 among hospitals with relatively poorer performance.ConclusionsAlthough the imaging efficiency measures help identify individual hospitals and hospital categories with relatively inefficient imaging practices, they do not readily identify distinctly positively performing hospitals. Excess utilization was suggested for lumbar spine MRI. Frequency of combination abdominal and chest CT examinations improved over a short time interval.     

Quality Measurements in Radiology: A Systematic Review of the Literature and Survey of Radiology Benefit Management Groups

PurposeAs the US health care system transitions toward value-based reimbursement, there is an increasing need for metrics to quantify health care quality. Within radiology, many quality metrics are in use, and still more have been proposed, but there have been limited attempts to systematically inventory these measures and classify them using a standard framework. The purpose of this study was to develop an exhaustive inventory of public and private sector imaging quality metrics classified according to the classic Donabedian framework (structure, process, and outcome).MethodsA systematic review was performed in which eligibility criteria included published articles (from 2000 onward) from multiple databases. Studies were double-read, with discrepancies resolved by consensus. For the radiology benefit management group (RBM) survey, the six known companies nationally were surveyed. Outcome measures were organized on the basis of standard categories (structure, process, and outcome) and reported using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.ResultsThe search strategy yielded 1,816 citations; review yielded 110 reports (29 included for final analysis). Three of six RBMs (50%) responded to the survey; the websites of the other RBMs were searched for additional metrics. Seventy-five unique metrics were reported: 35 structure (46%), 20 outcome (27%), and 20 process (27%) metrics. For RBMs, 35 metrics were reported: 27 structure (77%), 4 process (11%), and 4 outcome (11%) metrics. The most commonly cited structure, process, and outcome metrics included ACR accreditation (37%), ACR Appropriateness Criteria (85%), and peer review (95%), respectively.ConclusionsImaging quality metrics are more likely to be structural (46%) than process (27%) or outcome (27%) based (P < .05). As national value-based reimbursement programs increasingly emphasize outcome-based metrics, radiologists must keep pace by developing the data infrastructure required to collect outcome-based quality metrics.     

The impact of the financial crisis on human resources for health policies in three southern-Europe countries

The public health sector has been the target of austerity measures since the global financial crisis started in 2008, while health workforce costs have been a source of rapid savings in most European Union countries. This article aims to explore how health workforce policies have evolved in three southern European countries under external constraints imposed by emergency financial programmes agreed with the International Monetary Fund, Central European Bank and European Commission. The selected countries, Greece, Portugal and Cyprus, show similarities with regard to corporatist systems of social protection and comprehensive welfare mechanisms only recently institutionalized. Based on document analysis of the Memoranda of Understanding agreed with the Troika, our results reveal broadly similar policy responses to the crisis but also important differences. In Cyprus, General Practitioners have a key position in reducing public expenditure through gatekeeping and control of users’ access, while Portugal and Greece seeks to achieve cost containment by constraining the decision-making powers of professionals. All three countries lack innovation as well as monitoring and assessment of the effects of the financial crisis in relation to the health workforce. Consequently, there is a need for health policy development to use human resources more efficiently in healthcare.